Kenya Update 3 - Kisumu area

16 Feb 2012 - Miwani and Kisumu

My days are filled so far with medical facility evaluations and people meeting; making connections.

First the Nehemiah International Health Services building and staff –

Many photos taken today, and staff met. Esther, our Kenyan nurse, seems content and hard working; also very comfortable doing what she does.   No real sense of burn-out impending.  More on her on the next update.

Esther was thrilled to get her gifts today – new stethoscope, new headlamp – both from Dr. Dan Morris. I brought along some used equipment as well, all joyfully received.  They sure could use an otoscope to go with my tips I brought!

Lots of potential in our current building, just unsure how to use it all yet. Seems we need to get Dr’s. Omoto and Morris and nurse Anneliese – maybe Ken (our lab tech) too on skype and figure it out.

After a planning meeting it was off to Disciples of Mercy healthcare center. Ken and Anneliese and I spent almost 3 hours with “Saint” Natalie; we showing up unannounced. She has lived and worked here for 24 years. She outlined the plan of the transition of dispensary to healthcare center, which they have done over 5-6 years.

Deliveries, basic healthcare, STI’s, HIV testing, counseling, follow-up, family counseling, TB clinic, HIV support groups, community outreach and healthcare worker follow-up. They follow 436 active HIV/AIDS cases. Natalie estimates HIV is closer to 33%, not the reported 15% - due to all the money that has been poured in here not being used effectively, and that those funding care would withdrawal support if they knew the actual rate was 33%. This she feels is due to many not wanting testing (knowing from symptoms they have it), to factors such as if you only test well people without symptoms – you will miss many cases that would be obviously positive. Many would rather simply die of HIV/AIDS than to know they are +, others avoid testing to prevent family shame, many reasons to skip testing – even transportation.

I wish I had Natalie on film; she has a deeper understanding and knowledge of HIV/AIDS that almost any physician I have ever spoken to; way beyond my awareness – and yet she has no true medical education that I know of. The system and process they have in place is amazing. Testing, verification if +, TB screening, then a week of intense counseling, then ARV’s, then ongoing family counseling, then ongoing follow-up and compliance and blood testing for CD4 counts (cannot treat unless under 300) and LFT’s.

The Kenyan government supplies ARV medications for free, but all the necessary lab testing (such as CD4 counts, liver functions), personal and family counseling, case management, and compliance checks are also to be provided free of charge by healthcare centers. So it can be a huge financial burden for those providing care to follow these patients, yet the benefits great to each individual.

Many times today I was nearly overcome by emotion; just the burden of illness and the task to make a difference creatively with little to no funding and limited resources. 

Also nearly overcome with everything required to move our facility from dispensary to healthcare center – almost too many things to list. Inventory of durable goods and non-durables. Kenyan government criteria which are NOT in any one book or place, so hard to know what to do exactly until the inspector arrives. The required HIV/TB testing, separate rooms, and counseling services. Providing the necessary tests for free, despite the tests costing much. All the while obtaining funding and charging a low fee to those who can pay something. Yet I find encouragement in her spirit and heart.

She urged us to understand our mission, and to stick to that. If a donor wants something else accomplished, then they need to send their money elsewhere; but for her she wanted buildings to be able to move ahead.

Crazy traffic in Kisumu, no bother to paint lines on the roads since everyone drives where they want. Motorcycles, Piki-Piki’s (small 125cc engines – sometimes with 4 people on one bike!!), bicycles, carts pulled by hand, oxen, people, cars, buses, trucks, matatoo’s (Toyota mini-vans which are converted to hold around 14 people inside) many times people just hang outside the open doors! Three wheeled taxis as well.  Also right sided steering controls and speed bumps and potholes everywhere!! I mean everywhere – even on heavy trafficked roads, where they appear randomly and without signage of any sort. That, and police just hanging out to pull you over and collect road duty fees – which is a random act. Rather a strange system! 

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